Request for Transportation Under Act 372

PROCEDURE:

1. Complete a separate form for each student.
   Note: This form must be submitted no later than July 2nd, or transportation cannot be guaranteed by the start of school.
2. If approved, you will receive a confirmation e-mail verifying that your request has been approved.
3. New residents or change of residency to Souderton Area School District, please contact our Registration Office at 215-723-6061.

REQUEST FORM * = required
Student's First Name:*
Student's Last Name:*
Student's Date of Birth:*
Home Address:*
Street number and name:
City:		Zip:
Name of Non-Public School Attending:*	Select non-public school attending... Calvary Baptist School Center Square Montessori School Corpus Christi School Coventry Christian School Dock Mennonite Academy, EC-Grade 8 Campus Dock Mennonite Academy, Grades 9-12 Campus Faith Christian Academy Grace Christian School Gwynedd Mercy Elem. School Gwynedd Mercy High School Holy Cross Regional Catholic School Indian Valley Nursery School Lansdale Catholic High School Mary, Mother of the Redeemer Mater Dei School, Lansdale Penn Christian Academy Perkiomen School Pope John Paul II High School Quakertown Christian School Red Hill Christian School Souderton Brethren in Christ Nursery School & Kindergarten Souderton Charter School Collaborative St. Agnes-Sacred Heart School St. Isidore School St. Jude Catholic School St. Mary Catholic School United Friends School Upper Bucks Christian School Valley Forge Baptist Visitation BVM, Norristown Wyndcroft School OTHER (Please enter name of school in field below) If OTHER school attending, please indicate name of non-public school:
School Year Attending:*	Current year (i.e. student will be attending in 2024-2025) Upcoming school year (i.e. student will attend at start of 2025-2026)
Grade:*	Select a grade Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Approximately how many miles does the above named child live from their attending school?*	Select a distance from attending school... 1 2 3 4 5 6 7 8 9 10
Is the need for AM, PM or both?*	AM PM Both AM and PM
Did this child receive transportation from Souderton last year? If yes, please indicate bus or van number if known.*	Yes. Please indicate bus or van number if known: No
Parent/Guardian 1 Name:*
Parent/Guardian 1 Phone Number:*
Parent/Guardian 1 E-mail Address:*
Parent/Guardian 2 Name:
Parent/Guardian 2 Phone Number:
Parent/Guardian 2 E-mail Address:
I acknowledge that by checking this box this document is deemed signed.